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Dr. Vladimir Shvarts standing outside of Chris Hani Baragwanath Hospital during his first visit to Johannesburg, South Africa with the Barrow Global Neurology team.

Global Neurology: Expanding Expertise and Ending the Global Treatment Gap in Epilepsy Care

Guest Columns

Written by Vladimir Shvarts, MD, FACNS, Director, Barrow Epilepsy Center

Epilepsy, a neurological disorder affecting over 50 to 69 million people globally, disproportionately impacts low- and middle-income countries (LMICs), where nearly 80% of those affected reside¹. Despite the availability of effective treatments (predominantly antiseizure medications) that can render up to 64% of individuals seizure-free, a significant treatment gap persists, especially in LMICs, where more than 75% of people with epilepsy do not receive the care they need¹. This epilepsy treatment gap may reach up to as much as 90% in sub-Saharan regions of Africa. Additionally, comorbid medical, psychosocial, and socioeconomic conditions affect at least 50% of patients with epilepsy.

The World Health Organization’s Intersectoral Global Action Plan (IGAP) on Epilepsy and Other Neurological Disorders (2022–2031) provides a framework to address this disparity by enhancing access to care, promoting brain health, and reducing the stigmas associated with neurological conditions². IGAP outlines strategic objectives, including strengthening public health approaches to epilepsy, improving diagnosis and treatment, and fostering research and innovation².

Dr. Vladimir Shvarts in South Africa. He is giving a presentation.

A critical barrier to achieving these objectives is the shortage of specialized health care professionals. In Africa, the median number of neurologists is a mere 0 to 2 per 1,000,000 inhabitants, significantly below the WHO’s recommended minimum ratio of one per 100,000³ and the Association of British Neurologists estimation of 1 per 200,000. South Africa, for instance, has approximately 150 neurologists, with only about 35 serving in public sector hospitals that cater to nearly 80% of the population⁴. This shortage directly impacts timely diagnosis and management of epilepsy, further widening the treatment gap.

To bridge these gaps, there is an urgent need to develop and expand subspecialized faculty in neurology and epilepsy care. This can be accomplished through regional training courses, postgraduate medical education at international sites, the adaptation of innovative approaches (i.e., web-based learning programs, blended teaching programs, video-conferencing, and focused training and courses), and incorporation of traditional healers as a part of integrative care models. Training programs that equip health care providers with specialized knowledge in order to allow local establishment of tertiary level care centers and programs should be prioritized.

Institutions like Witwatersrand University are producing the next generation of neurologists and are among the highly qualified sites that can develop specialized centers to address the existing treatment gap for patients with epilepsy. Barrow Neurological Institute is honored and proud to partner with them to help equip this and the next generation of local neurologists with subspecialized training, and provide exposure to cutting-edge neurological and neurosurgical care in order to build a strong foundation that promotes the growth of local expertise and ability to care for the patients with seizure disorders.

Dr. Vladimir Shvarts in South Africa. He and others are looking at a computer screen.

Global collaboration and investment are essential to support these initiatives. By prioritizing the development of subspecialized faculty, promoting epilepsy awareness, and strengthening health systems in alignment with IGAP objectives, we can move toward a future where access to epilepsy care is a reality for all—regardless of geography and socioeconomic status.

The recent visit to Chris Hani Baragwanath Hospital by the Barrow team has been an enlightening experience. The scope of the medical care provided at a facility of such magnitude and complexity was intimidating and inspiring at the same time. There is a tremendous unfulfilled need for more providers, specialized equipment, treatment options, and subspecialty training. At the same time, it is also very clear how dedicated the local physicians and nurses are to providing the best possible care to their patients. Their resourcefulness and ingenuity were apparent both in the inpatient and outpatient settings on numerous occasions. Both trainees and seasoned physicians were eager to learn any new information and acquire advanced skills to facilitate more nuanced treatment plans for their patients.

Barrow Neurological Institute partnering with Witwatersrand University to facilitate both on-site and remote training as well as educational exchange will undoubtedly be a fruitful collaboration for both institutions with an ultimate result of a more thoughtful and specialized care available to the patients of South Africa and more global prospective on neurological care by physicians and trainees at our institution.

Dr. Vladimir Shvarts in a clinic in South Africa

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